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Postgraduate Education Corner: CHEST IMAGING AND PATHOLOGY FOR CLINICIANS |

Chest Pain and Progressive Miliary Infiltrates in an Elderly Man

Jeffrey B. Rubins, MD, FCCP; Robin Solomon, MD; Thomas Colby, MD, FCCP; Rosemary Kelly, MD, FCCP
Author and Funding Information

*From the Pulmonary Division (Dr. Rubins), Pathology Department (Dr. Solomon), Thoracic Surgery Department (Dr. Kelly), Minneapolis Veterans Affairs Medical Center, University of Minnesota, Minneapolis, MN; and Pathology Department (Dr. Colby), Mayo Clinic, Scottsdale, AZ.

Correspondence to: Jeffrey B. Rubins, MD, FCCP, Pulmonary 111N, One Veterans Dr, Minneapolis, MN 55417; e-mail: rubin004@umn.edu


None of the authors have relevant financial or academic conflict of interest with any of the information discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2009;135(2):578-582. doi:10.1378/chest.07-3002
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Extract

An 81-year-old man presented with persistent dyspnea and left pleuritic chest pain for 2 months following a left lower lobe pneumonia treated at another institution. He denied undergoing thoracentesis or pleural catheter drainage during treatment of the pneumonia. He reported resolution of cough, and denied hemoptysis, fever, night sweats, or weight loss. His exposure history included working on a farm as a teenager and in iron mines for 4 years in the 1950s, and retail sales work thereafter. He was a life-long nonsmoker, had no significant travel history outside of Minnesota, and his only pets were two cats and a dog. He specifically denied exposure to tuberculosis, asbestos, or silica. His medical history was significant for hypertension, gastroesophageal reflux disease, and prostatic adenocarcinoma (Gleason grade 3 + 4, score 7), treated with radiation therapy 5 years previous, with a currently normal serum prostate specific antigen. His medications included atenolol, felodipine, hydrochlorothiazide, lisinopril, omeprazole, and enteric-coated acetylsalicylic acid. Physical examination revealed small mobile cervical adenopathy, decreased breath sounds at the left lung base, and no edema or clubbing.

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